Ah, surgeons.
I never thought I'd want to go into surgery. Ever. It never sounded fun to me. It was never fun to me before going to PA school and it continues, surprising no one, to be about as fun as shoving my head into a revolving doorway. Maybe it's that I'm disappointed. Saddened and let down that surgeons and surgical staffers reinforce, daily, the negative stereotype I hoped to see undone a little bit. Maybe it's the paradoxical abstraction that surgery is for me. That, despite everything, even though you open up the chest or the vessels or the belly, you have to sew them back up again, and then you have no way of seeing, of having some kind of concrete knowing, that what you've done was better than what was before. I mean, you can. You have indirect parameters that indicate whether the patient's outcome is now better or worse than it was before. Whether they spike a fever, become increasingly painful, the amount of fluid accumulating in their drains, the way their incision looks. But it's all going on deep down and underneath, and you can't go back in there without inflicting more trauma.
Perhaps it's simply the barbarism of cutting someone open, splaying out their vulnerable insides, putzing around with their guts. Perhaps it's the fact that I feel the need to wear a jock strap just to anneal myself for morning report, that the arrogant, testosterone-riddled chest puffing is positively aromatized and you can feel it hanging in the air around you, clinging to everything. Perhaps it's that I don't understand why humiliation and venom and vitriol are necessary learning tools and that I've never once seen the need, or good, of hazing. Perhaps it's that I find little else more frightening than hubris and impudence, the inability to consider the failings of oneself.
This week my surgical team was lead by a senior resident who conducts morning rounds in the same way you or I would hock a loogie. Sometimes we're lucky and he speaks in a muted, wordless language discernible only to dogs and three rare species of Pacific Northwest Humpback Whales. The rest of the time, he scowls and screams. He is the kind of person who stands by the door and waits for you to open it, is two inches from the gloves but will stare at you from across the room if you don't walk around the ventilator, tripping up in the arterial lines and fluid bags and blood products, to hand the gloves to him. We all tromp in, all eleven of us, in scattered formation and at 6:30 in the morning. We flick on the lights, throw down the bed covers, inspect the incisions. We prod and poke and say, "DOES THIS HURT? RIGHT HERE? WHAT I'M DOING TO YOU? LIKE THIS? IS THIS HURTING WHEN I PRESS MY FINGER INTO YOUR GAPING FLESH WOUND? WHAT DO YOU MEAN YOU'RE NOT SLEEPING? OF COURSE IT HURTS, YOU JUST HAD SURGERY". We strip off the bandages, rip off the tape. We scurry around with gauze and bandage material and boxes. The only things we care about is if someone has been able to fart, shit and is not vomiting. Everything else? Oh, your mother died in a freak meteor accident while you were on the table and now you don't want to go on living? Sucks--and then whispered to the third year: get a psych consult this lady is crazier than bat shit in Ecuador. Actually, he didn't say that. Because that would be kind of funny and nothing about my days are funny. He just stared at her and then told the residents to change her pain medication because he didn't think the morphine "agreed" with her.
Above everything, I guess it's the persistent, consistent, complete separation between patient and surgeon that is perpetuated completely and absolutely. There is rarely a previous relationship, hardly an understanding of the patient beyond their ruptured gall bladder, their obstructed intestine, their malignant mass. In too many ways, we are allowed (encouraged) to forget that our patients are people beneath the sterile, blue draping and not just discrete organs that need resecting or repairing or replacing. It is frightening how quickly you loose sight that what you are doing is mucking around in a human, not just looking for the great vessels of the spleen. In favor of focus we have created a single mindedness that is at its best insensitive and at it's worst, humiliating.
But in the end, it isn't just the cutting people open, the scalpel to skin aspect that I have such a great disconnect with. It's the willingness to work one hundred and forty three bazillion hours a week, to completely forgo sleep in its entirety, the mutant, alien ability to circumvent the otherwise universal need for glucose, the penchant for sustaining excruciating, tortuously painful physical postures for hours at a time. I know that one way of looking at life in surgery, the most optimistic, is to focus on the fact that you have this incredible access of being able to fix people. They come in, they need to be splayed open and repaired, you do that, and then you leave. Another way of looking at it is that you intentionally inflict onto people enormous amounts of pain. Every step of the way. Ultimately, the cost to do this, to work in surgery--the expense in years of life, personal relationships, the humanity lost, sleeping for little more than 17 hours a week---is too great. Some people want to do it for money, others for a more intangible reward. There are so many people for whom surgical jobs and surgical residencies are the be all end all of their entire lives presently. For me, however, if medicine as a whole were anything like fishbowl of surgery I am certain that I would not be where I am today, surrounded by text books, calling this my life.
